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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY All <br /> OBA"� i� � ' _ s ADDRESS <br /> MAILING ADDRESS i <br /> Js�a v <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I 2 Additional Tanks x $50) U / <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit andtemporary closure) <br /> ($56 x Total N ? Tanks) /� F i <br /> 3. "Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (/_ Temporary closures x $80) (See above 03 to., calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank . <br /> (I� Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> withour check. I <br /> Y jj <br /> V <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (I regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility b Ist Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> z -26 • <br />